surgeon for revision jaw and nose, help needed! photos added

[kavan]

Ok very useful presentation of how bone cutting and shaving can be used together in these v-line procedures. Thanks! Again, learned something new.

Also I think for OP the blue statement at the end is important!

Raya, check the statement in blue by kavan in the picture.
.... It would not call for another bone cutting surgery.

You are a very good recipient for learning.

As to the (basic) 'V line' surgery, I go by the KOREAN approach in which they use basic geometrical concepts to change the shape of one figure to another which involves planning types of cuts to displace/remove bone. For the most part, they use sharp cutting instruments for the main shape and reserve burring and/or shaving to later 'round out' residual (or unwanted angularity). I mention that because some surgeons call what they do 'V line' but it is NOT the Korean approach.

Korean approach resolves to solving this basic geometric question which is:

Q: 'Given the wide and blunt chin contour in scull 'a', HOW would you get to the contour of scull 'd' using cuts and bone displacement/removal. Also, WHEN would burring/shaving be used?

A: 'Via a horizontal cut through the (wide) chin and 2 vertical cuts below, spaced a distance apart equal to the excess width. Remove middle segment and move the lateral segments inward to close the gap. Then a straight line diagonal cut from the 'step-off' to the back of the jaw angle. Burring would be reserved for rounding out residual angularity to the posterior jaw for a more (overall) 'rounded' V contour IF all angularity to mandible were to be removed.
------------------------
Now, as to the after scull scan, the surgeon was tasked with UNDOING an overly shortened chin (and calling it a 'V line). Except for the scalloping on right side of PHOTO, as you pointed out, that could be camouflaged with some soft tissue filler.

[kavan]

thank you for thinking along. sorry for the bad presentation. I'm not very good at it.
it's also chaos in my head because so much has happened. I don't have the last scan yet because the doctor claims that everything went well. She won't explain to me what happened.

I did indeed have a djs with a genioplasty. they had placed the chin back crookedly and  hadn't taken the sides of the jaw which made me feel this. as seen in this scan and Photo.

https://imgur.com/a/d5tAaXq

https://imgur.com/a/g0ivBg3

I then went to Dr defranq for a consultation. He wanted a downgraft upper jaw and a cw setback lower jaw to return to my old face as best as possible. I had then visited a doctor in the Netherlands. she could do the same, she said with a v line (that's what she called it). so apparently she has removed too much of the side of the jaw, so that why my chin is crooked.

as you van see in the picture my lower jaw is too far forward, like a male lower jaw. now I am looking for a doctor who can do the downgraft upper jaw and setback lower jaw for me as Dr Defranq said.If you look at my scan you think it is feasible.



Thanks!

1: I used the scull scan from link https://imgur.com/a/d5tAaXq in my observations which I posted on here.

2:In this thread, I've mentioned that I can't see all IMGUR links (because imgur flashes them for a fraction of a second). So, can't see link https://imgur.com/a/g0ivBg3  and link of DeFranc's simulation. This board allows one to upload photo files directly on here though.

3: The after scans don't really reveal 'removal' to sides of jaw, yet alone 'too much'. They reveal bringing down the chin to BLEND IN with the step offs left by the prior surgery. Unlikely that the scalloped area is from removal. More likely that all could not be blended in perfectly due to prior chin shortenting.

4: Your after scan shows more (a zygomatic osteotomy) than you said you had. There are a lot of screws connecting into the maxilla area in vicinity where another bone cut would be made. In the event your jaw/s looked too forward to you BUT you had 'bimax protrusion' (looks like you could have that), you would probably be dissatisfied with another surgery and I'm disinclined to suggest continued revision surgery.

[Tomasjohn]

You are a very good recipient for learning.

As to the (basic) 'V line' surgery, I go by the KOREAN approach in which they use basic geometrical concepts to change the shape of one figure to another which involves planning types of cuts to displace/remove bone. For the most part, they use sharp cutting instruments for the main shape and reserve burring and/or shaving to later 'round out' residual (or unwanted angularity). I mention that because some surgeons call what they do 'V line' but it is NOT the Korean approach.

Korean approach resolves to solving this basic geometric question which is:

Q: 'Given the wide and blunt chin contour in scull 'a', HOW would you get to the contour of scull 'd' using cuts and bone displacement/removal. Also, WHEN would burring/shaving be used?

A: 'Via a horizontal cut through the (wide) chin and 2 vertical cuts below, spaced a distance apart equal to the excess width. Remove middle segment and move the lateral segments inward to close the gap. Then a straight line diagonal cut from the 'step-off' to the back of the jaw angle. Burring would be reserved for rounding out residual angularity to the posterior jaw for a more (overall) 'rounded' V contour IF all angularity to mandible were to be removed.
------------------------
Now, as to the after scull scan, the surgeon was tasked with UNDOING an overly shortened chin (and calling it a 'V line). Except for the scalloping on right side of PHOTO, as you pointed out, that could be camouflaged with some soft tissue filler.

Thanks for the explanation!